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General NPI Number Information
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NPI Number | 1629882121
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Entity Type | Organization
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Legal Business Name | HEALTHSOURCE OF MERIDIANVILLE
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 11850 HIGHWAY 231 431 N STE J
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City | MERIDIANVILLE
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State | AL
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Zip | 35759-2126
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Country | US
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Telephone | 217-381-7825
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Fax |
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Provider Business Mailing Address
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Address Line | 11850 HIGHWAY 231 431 N STE J
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City | MERIDIANVILLE
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State | AL
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Zip | 35759-2126
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Country | US
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Telephone | 217-381-7825
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JACOB DEAN MATHIAS
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Credential |
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Telephone | 256-874-2643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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